October 17, 2011

Exploring why girls in sub-Saharan Africa are vulnerable to HIV

A new study led by researchers at the Johns Hopkins Bloomberg School of Public Health shows that community members correlate an increase in HIV vulnerability among adolescent girls with weak structural support systems.

While adolescent girls are three to four times more likely than adolescent boys to be living with HIV/AIDS in sub-Saharan Africa, few studies have examined the reasons why community members believe girls are so vulnerable to HIV. The findings are published in the journal Social Science & Medicine.

Carol Underwood, lead author of the study and an assistant professor in the Bloomberg School’s Department of Health, Behavior and Society, said, “This study represents one of the few efforts to explore community members’ perceptions of vulnerability to HIV. It is unique because it offers insights into developing an HIV response that is grounded in the views of communities most affected by HIV/AIDS rather than a response based primarily on perspectives from the outside.”

Underwood directed the Gender Initiative on Girls’ Vulnerability to HIV—known as the Go Girls! Initiative—an intervention informed by this study and carried out by the Bloomberg School’s Center for Communication Programs. The Go Girls! Initiative used focus group discussions with adolescent girls and boys, adult men and women and community opinion leaders, in Botswana, Malawi and Mozambique to develop social, gender and behavior change communication approaches to reduce adolescent girls’ susceptibility to HIV infection.

The study found that structural factors, especially insufficient economic, educational, sociocultural and legal support for adolescent girls, were identified as the root causes of girls’ vulnerability to HIV through exposure to unprotected sexual relationships, primarily relationships that are transactional and age-disparate. This finding is in line with current HIV prevention practice, which advocates for combination prevention that comprises biomedical, behavioral and structural interventions.

“Nevertheless, while greater attention is being paid to the importance of structural interventions in HIV prevention efforts, most efforts still focus on the individual and disregard the complex socio-economic context where the infections are occurring, a situation which must be met with nuanced and multilevel responses,” Underwood said.

“We found that both adolescents and adults in HIV-affected communities highlighted structural interventions, behavioral interventions and testing—in that order—for prevention,” she said.

Community members explicitly called for policies and interventions to strengthen cultural, economic, educational and legal structures to protect girls, findings that were used to develop the interventions implemented by the Go Girls! Initiative.

Authors of the study are Underwood, Joanna Skinner and Hilary Schwandt, all of Johns Hopkins; and Nadia Osman, of the World Food Programme.

Funding for the research was provided by the President’s Emergency Plan for AIDS Relief and the United States Agency for International Development.